Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients

Hung, Szu Chun; Hung, Sze Hung; Tarng, Der Cherng; Wu, Yang Chang; Chen, Tzen Wen; Huang, Tung Po

doi:10.1053/ajkd.2001.28578

Cited by 123 publications

(60 citation statements)

References 16 publications

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“…Wernicke's encephalopathy is a result of thiamine (vitamin B1) deficiency and is classically reported to present with a triad of ophthalmoplegia, ataxia and disturbances to cognition or consciousness. 20 It has been suggested that poor nutrition and loss of watersoluble vitamins through dialysis place CKD patients at high risk of this type of encephalopathy.…”

Section: Encephalopathy and Deliriummentioning

confidence: 99%

Neurological complications of chronic kidney disease

2009

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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Section: Encephalopathy and Deliriummentioning

confidence: 99%

Neurological complications of chronic kidney disease

2009

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“…The dialysis procedure is a widely accepted risk factor for the onset of Wernicke encephalopathy, and most probably this life-threatening condition is largely underdiagnosed [7,8,9,10]. Also, thiamine deficiency is regarded as one of the causative factors in dialysis-related encephalopathy [9,11]. Therefore, the elucidation of the role of HD in maintenance of vitamin B1 status is an issue of preeminent importance.…”

Section: Introductionmentioning

confidence: 99%

Thiamine Diphosphate Status and Dialysis-Related Losses in End-Stage Kidney Disease Patients Treated with Hemodialysis

et al. 2017

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Aim: (1) To describe the whole blood content of thiamine diphosphate (TDP), a biologically active form of vitamin B1 in end-stage kidney disease patients treated with hemodialysis (HD); (2) to establish the impact of a single HD procedure on TDP blood concentrations; and (3) to describe potential explanatory variables influencing TDP dialysis related losses, including dialysis prescription, vitamin B1 dietary intake and supplementation. Methods: Single-center, cross-sectional study in 50 clinically stable maintenance HD patients. The assessment of whole blood TDP with the High Performance Liquid Chromatography method, before and after a single, middle-week dialysis session and analysis of clinical and laboratory parameters potentially influencing TDP status Results: We report a significant difference in TDP levels before and after HD sessions - 42.5 (95% CI 38.7-46.2) μg/L and 23.6 (95% CI 18.9-28.2) μg/L, respectively (p = 0.000). The magnitude of intradialytic TDP changes is highly variable among individuals and is negatively associated only with the body weight of the patients (p < 0.013). Vitamin B1 dietary intake and supplementation do not influence whole blood TDP and dialysis-related loss of TDP. Conclusions: TDP, a bioactive compound of vitamin B1, is substantially lost during the HD procedure, and the magnitude of its loss is associated with the patient's body weight but it is not influenced by vitamin B1 dietary intake and standard supplementation dose.

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“…According to the Kidney Disease Outcomes Quality Initiative K/DOQI Recommendations for Nutriwater-soluble vitamins that have been studied, serum levels of ascorbic acid, thiamine (B 1 ), pyridoxine (B 6 ), and folic acid have all been reported to be low in dialysis patients (Gilmour et al , 1993 ). Thiamin defi ciency with encephalopathy has been described in dialysis patients (Hung et al , 2001 ) and may be confounded by other neurologic diseases. A common dietary intake of 0.5 to 1.5 mg/day may be supplemented with a daily dose of 1 -5 mg of thiamin hydrochloride.…”

Section: Nutrition Counselingmentioning

confidence: 99%